Post ICD-10 transition, the ICD-10 Quality Assurance & Education Manager will work closely with Revenue Cycle, Patient Accounting and HIM to resolve unbilled account issues and to identify and resolve obstacles and inefficiencies that delay timely coding and abstracting.

Primary Functions:

Education• Provide ICD-10 educational support for employees and contracted resources• Educate coding staff, CDIS, physicians and others throughout the organization who require ICD-10 coding and documentation knowledge (training to include ICD-9, ICD-10, CPT, HCPCS, IPPS, OPPS, APC, DRG and other relevant state and federal laws and regulations)• Provide expert guidance on ICD-10 coding and DRG assignments to the Revenue Cycle and Managed Care staff

Denial ManagementAssists with working ICD-10 coding related denials and provides feedback to each provider based on identified denial trends or assists in appeals if payer ICD-10 application or logic is invalid. Implement changes and provide education & feedback to providers, departments and clinics with regards to denials that impact revenue flow and or capture.

Conducts research and analysis of claims data and medical records information to determine the accuracy of payment, appropriateness of coding, and adequacy of supporting clinical documentation as directed by ICD-10 Director; works collaboratively with Health Information Management, Managed Care, Quality, Clinical Documentation, Physician Services, Rehab etc. to resolve cases.

Well developed written and verbal communication skills, including the ability to positively interact with executives, providers and staff at all levels; strong facilitation and presentation skills (REQUIRED)